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/r/Medicine! I was wondering, when you have students who do rotations through your clinics or perhaps interns or first year residents, what is the best advice you could give them to be perceived as good interns/residents? Besides the obvious showing up on time and doing what's asked of you.

Anticipation. Know exactly what you'll do if a result comes back; think ahead to what your patient will need to be discharged the second you begin your admission note. Learn the likely recommendations or orders of your attendings and be ready with results they're likely to ask for. Begin to learn which of your co-interns are slackers or perform poorly under sleep deprivation or are not thorough, and the missing pieces they'll burn you with when you're cross covering on call or on night float. In all, play the chess game thinking as many moves ahead as you can so that when you're tired and post-call, you've set your patient on a path that requires little conscious effort on your part.

And call in backup. Pride is stupid. Patient safety is not and if you think there's even a chance of you being overwhelmed when you're on call or covering night float, call in your backup and make sure that you documented that you did so.

In the chart: "Blood pressure resistant to initial attempts at pharmacologic control, discussed with cardiology fellow who will see patient and recommend therapy."
If something bad happens to your patient and there ISN'T evidence in the chart that you went for help for a problem you could have fixed by asking someone with more knowledge, that is how you become the subject of a M&M.

just to add to your reply about documentation. EMR is great but it can actually lead to easier mistakes by just copying previous notes. Make sure to actually check what other doctor's have noted even if they are your upper residents/ attendings/ or specialists. You don't want to be part of a lawsuit just because you copied a note.

Show up early, and do more than what's expected of you. If you're waiting to be told what to do as an intern, then you've missed the point. Check on your patients again. Know their history cold. Anticipate what the next big move is going to be.

Know that you are your patient's main (and sometimes only) advocate for getting them through their hospital stay. If you don't push for a relevant study or prepare discharge plans early on and don't push for it aggressively and proactively, then it WILL extend the patient's hospital stay, and nobody wants that.

A couple specific pieces of advice (simply because I have seen it recently), is knowing your patients and consults very well on rounds and when presenting to your seniors. They expect that you can do the grunt work (show up on time, update the list, write orders...), but you really make their lives easier when you can come to them with a new consult and present the pertinent facts with as little minutia as possible (plus, you learn more). The best way to achieve this, as another posted, is to pretend you are the only physician. The disappointment is palpable when an intern presents, "the ER doc thinks its appendicitis" and he or she forgot to palpate the abdomen and "haven't looked at the labs yet..."

Another key is making an effort to not make your lack of experience or medical knowledge painfully obvious. Don't ask incredibly basic questions that you can look up later. A good example was an intern who paged his senior in the OR the other day, the nurse had to retrieve the pager, and return the call. The intern asked, "I know you wanted 2 of cefoxitin, is that milligrams or grams?" Most wouldn't fault an intern for not knowing an antibiotic dose, but given that he knows "2" of something... it shouldn't require a great leap in cognitive ability to figure out the rest without calling your senior.

I agree that you should try and figure it out yourself, but I am completely against suggesting someone not ask. I always make sure to ensure my interns know that they can ask anything, anytime. Not just because I want them to learn but for safety and the patient's sake as well. But don't get me wrong here, asking "dumb" questions will get you looked down upon by most people above you... shouldn't be in my opinion because we all started not knowing things.

This is my biggest fear. On one hand I have learned the "never make assumptions" rule, but then that means I ask confirmation questions that could make me look dumb. I guess if I ask confidently it's OK? Right???

[–]ms4evaIM - Hospitalist, but I could be a liar.3 points4 points5 points3 years ago(1 child)

I think the key is knowing who you're working for, because some of them will not like this. Also, try and phrase your questions well to sound like you are asking about more detail about a particular thing. Also, if you ever have questions you can send them my way, though I may be slow to answer sometimes. :)

organization. Clinical accumen will come with time and experience but if you can organize the tasks assigned to you and arrange them in order of most pressing to most trivial, you will have a nice transition.

never take a longer lunch break than the staff- & do not ever let ANY staff member (because they talk) catch you hiding out texting, on your phone, etc. i immediately disengage the second i find out a student is doing these things and shift my time and help towards students that have the courtesy to put their phones away and actually work.